Close to half of transgender young Canadians aren’t accessing health care when they need it, according to a new study from the University of British Columbia.

The study also found that increasing confidence in health-care providers is important for improving the physical and mental health of transgender youth.

Researchers analyzed data from 923 youth ages 14-25 who responded to a countrywide transgender youth health survey conducted in 2013-2014. Overall, the survey found participants didn’t feel comfortable talking with their doctors about their gender or trans-specific health-care needs.

Sixty-eight percent of younger youth (ages 14-18) had forgone needed mental health care in the last 12 months, and 34 percent did not seek professional care for physical problems even when it was needed. Among older youth (19-25), 47 percent had forgone mental health care, physical health care, or regular checkups.

In some cases, young people did not seek care because they hoped the problem would go away on its own, or because of issues with cost or transportation. However, many reported previous negative health-care experiences, or being afraid of what a doctor would say or do, as reasons for not getting care.

Many participants described negative encounters with health-care providers, such as being denied routine prescription refills by clinicians unfamiliar with providing gender-affirming care.

“Many transgender youth have experienced uncomfortable and frustrating encounters with doctors, particularly when a doctor isn’t well informed about transgender health,” said lead author Beth Clark, a PhD candidate in interdisciplinary studies. “An encouraging finding was that young people who were more comfortable discussing trans health-care needs with their family doctors reported higher levels of mental health and health overall.”

The analysis showed that people whose transgender identity was known by their doctor reported better general health than those who said their doctor was unaware, or those who weren’t sure if their doctor knew. Youth who reported their doctors knew they were transgender also reported better overall mental health than those whose doctors did not know.

Study senior author Elizabeth Saewyc, a nursing professor who leads the Stigma and Resilience Among Vulnerable Youth Centre at UBC, says the results highlight the need for a more supportive and informed approach in health care for transgender youth.

“Trans youth have higher risk for negative health outcomes due to stigma and discrimination, so knowing that they don’t access health care even when they need to is concerning. The responsibility lies with us–with health professionals, health educators, and policymakers–to improve our competency in transgender health and ensure our trans patients can have confidence in the health care they receive,” said Saewyc.